Michael E C Mcfarlane

• MBBS, DM, FRCSEd, FACS, FICS
• Professor at University of the West Indies

Background Breast cancer is the leading cause of cancer and cancer related deaths in Jamaican women. In Jamaica, women often present with advanced stages of breast cancer, despite the availability of screening mammography for early detection. The utilization of screening mammography for early breast cancer diagnosis seems to be limited, and this st...

Abstract — This review aims to discuss the advances in artificial intelligence (AI) and the role it now plays in surgery. The discussion outlines the many capabilities of AI in improving the way in which surgery is conducted and a critical review of new AI developments. Artificial intelligence now well established in several industries has now begu...

Primary breast lymphoma is a rare disease, which accounts for 0.4% of all malignancies seen in the breast and 2% of extranodal lymphomas. The majority of cases are B-cell lymphomas, with diffuse large cell (B) lymphoma the predominant histological type. A variety of treatment modalities have been suggested, with radiation therapy recommended for st...

Acute colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of acute left-sided colonic diverticulitis (ALCD) according to the most recent available...

Patients with sickle cell disease (SCD) are high-risk for perioperative morbidity and mortality. The establishment of guidelines in the management of cholecystectomy, one of the most common surgical procedures in the sickle cell population, will form the basis for streamlining care, nationally. The guidelines were established based on current liter...

Purpose Conscious sedation is regularly used in ambulatory surgery to improve patient outcomes, in particular patient satisfaction. We hypothesized that the addition of conscious sedation would provide greater patient satisfaction with inguinal hernioplasty compared to local anesthesia alone. Methods This trial was a single-centre, randomized, pla...

Full Edition of the JCCS 2019;1

[Background] Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatmentof choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate.The management can become difficult in case of complicated appendicitis. The aim of this study is to describethe worldwide clinical an...

Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons a...

Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons a...

Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons a...

The Global Alliance for Infections in Surgery appreciates the great effort of the task force who derived and validated the Sepsis-3 definitions and considers the new definitions an important step forward in the evolution of our understanding of sepsis. Nevertheless, more than a year after their publication, we have a few concerns regarding the use...

This declaration, signed by an interdisciplinary task force of 234 experts from 83 different countries with different backgrounds, highlights the threat posed by antimicrobial resistance and the need for appropriate use of antibiotic agents and antifungal agents in hospitals worldwide especially focusing on surgical infections. As such, it is our i...

1. Surg Infect (Larchmt). 2017 Nov/Dec;18(8):846-853. doi: 10.1089/sur.2017.219. A Global Declaration on Appropriate Use of Antimicrobial Agents across the Surgical Pathway. [No authors listed] This declaration, signed by an interdisciplinary task force of 234 experts from 83 different countries with different backgrounds, highlights the threat...

This corrects the article DOI: 10.1186/s13017-016-0089-y

The original article [1] contained an error whereby a co-author, Boris Sakakushev had their name spelt incorrectly. The original article has now been updated to display Dr. Sakakushev's name correctly.

Abstract Background Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical...

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoi...

Background Conscious sedation is regularly used in ambulatory surgery to improve patient outcomes, in particular patient satisfaction. Reports suggest that the addition of conscious sedation to local anesthesia for inguinal hernioplasty is safe and effective in improving patient satisfaction. No previous randomized controlled trial has assessed the...

Introduction Lymphedema is characterized by a defect in the lymphatic system that causes limb swelling. Impaired uptake and transport of lymphatic fluid through lymphatic vessels causes accumulation of protein-rich fluid in the interstitial spaces, which leads to swelling of the limb. Primary lymphedema often presents at birth. The rare cases that...

Acute left sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in acute setting. A World Society of Emergency Surgery (WSES) Consensus Conference on acute diverticulitis was held during the 3rd World Congress of the WSES in Jerusalem, Israel, on July 7th, 2015. During this consensus conference the guid...

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of...

Objective: To determine the intermediate and long-term survival of patients diagnosed with colorectal cancer (CRC) and to determine factors that affect survival. Method: Patients were identified from a prospectively maintained colonoscopy database. All patients who underwent colonoscopy during the period January 2008 to December 2012 and had his...

Background To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. Metho...

Objective: To determine the quality of surgical management offered to patients with colorectal cancer (CRC) as measured by adequacy of nodal resections and compare variations across the major hospitals in Jamaica. Method: Data was obtained from the CRC Registry of patients diagnosed and treated surgically for CRC during the 3-year period commencing...

Colonic diaphragm is a rare complication of chronic use of non-steroidal anti-inflammatory drugs. Though benign, life-threatening complications such as intestinal obstruction and anaemia may ensue. Distinguishing colonic diaphragm from other causes of intestinal obstruction such as malignancy is often difficult, with patients often requiring surgic...

The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear. In severe abdominal sepsis the OA may allow early identification...

Scarless/single-incision laparoscopic cholecystectomy (SILC) is a new procedure. It affords a superior cosmetic outcome when compared to conventional laparoscopic cholecystectomy. We examine the application of this technique using LigaSure via a clipless method. The present study looks at the experience of a single surgeon using this method with in...

Computed tomography (CT) imaging is the most appropriate diagnostic tool to confirm suspected left colonic diverticulitis. However, the utility of CT imaging goes beyond accurate diagnosis of diverticulitis; the grade of severity on CT imaging may drive treatment planning of patients presenting with acute diverticulitis. The appropriate management...

Computed tomography (CT) imaging is the most appropriate diagnostic tool to confirm suspected left colonic diverticulitis. However, the utility of CT imaging goes beyond accurate diagnosis of diverticulitis; the grade of severity on CT imaging may drive treatment planning of patients presenting with acute diverticulitis. The appropriate management...

Dengue fever is an acute viral disease, which usually presents as a mild febrile illness. Patients with severe disease present with dengue haemorrhagic fever or dengue toxic shock syndrome. Rarely, it presents with abdominal symptoms mimicking acute appendicitis. We present a case of a male patient presenting with right iliac fossa pain and suspect...

Despite the fact the mucocoele of the appendix is a rare entity it has been the subject of much interest in the literature. The term mucocoele refers to cystic dilatation of the appendix filled with mucin resulting from proximal obstruction of the appendix lumen. We report two patients presenting with mucinous cystadenoma of the appendix with eleva...

Background: The finding of adenocarcinoma arising in an excised haemorrhoid is an unexpected phenomenon that has been rarely reported. Even the pathological examination of all haemorrhoids has been questioned and no standard recommendation regarding this practice has been adopted. Case Presentation: Herein we present the case of a 59 year-old patie...

Actinomycosis is an uncommon chronic suppurative infectious disease that is caused by Actinomycetes organisms, which are gram-positive, microaerophilic, anaerobic bacteria. The most common type causing disease in humans is Actinomyces israelii. This organism is a commensal of the human mouth and is seldom pathogenic. When it does cause disease, how...

BACKGROUND: Massive lower gastrointestinal haemorrhage resulting from a fistular communication between an internal iliac artery aneurysm and colon is a rare occurrence. Early diagnosis and treatment is difficult because of the anatomical location of these aneurysms and only made when they become significantly enlarged. METHODS: Case report. RESULTS...

The presence of a large bulky pancreatic tumour in a young female should raise suspicions of the diagnosis of solid-pseduopapillary tumour of the pancreas. This rare tumour has the characteristics of a low-grade malignancy with indolent behaviour. Most patients present with vague non-specific abdominal pain resulting in delayed diagnosis. The light...

Progressive surgeon specialization has been shown to result in improved patient outcomes for many surgical procedures. This has been demonstrated in improved survival following cancer surgery and improved operative morbidity and mortality for other procedures. Concentrating complex surgical cases in centres where case volume and expertise exist sho...

Jejunouterine fistula is a rare type of fistulous communication between the small intestine and the genital tract. This fistula may result from pelvic tumours, obstetric or surgical intervention and inflammatory disease. Cross-sectional imaging modalities, including ultrasonography, magnetic resonance imaging (MRI) and computed tomography (CT), are...

Increasing numbers of severely injured patients have been presenting to Emergency Rooms worldwide due to advances in pre-hospital trauma care. Some of these patients may be candidates for Emergency Department Thoracotomy (EDT). Large advisory bodies have identified selection criteria for EDT in Developed Countries, but there are no regional statist...

We present the case of a patient with the rare combination of chylous ascites and chylothorax resulting from penetrating abdominal injury. This patient was successfully managed with total parenteral nutrition. This case report is used to highlight the clinical features and management options of this uncommon but challenging clinical problem.

This manuscript highlights the financial benefits derived from fistuloclysis when used for nutrient delivery in patients with enterocutaneous fistulae.

Metastases to the breast from extramammary neoplasms are rare. Few cases of melanoma metastatic to the breast have been described in the literature. Correct identification of metastatic breast malignancy is of great significance since this presentation may be confused with primary benign or malignant breast disease.

The objective of this study was to examine the clinicopathologic features of gastric cancer seen at the University Hospital of the West Indies (UHWI) and to compare the findings with other studies. A retrospective study was conducted using data obtained from the surgical pathology reports of all gastrectomies and gastric biopsies during the period...

The objective of this prospective study was to evaluate the role of intraoperative cholangiography (IOC) for patients undergoing laparoscopic cholecystectomy (LC) to determine whether it could be safely omitted for all patients who fit standard criteria, namely normal liver function tests, no history of gallstone pancreatitis, common bile duct (CBD...

The objective of the study was to demonstrate the effectiveness of infrared photocoagulation (IRC) for the outpatient treatment of internal haemorrhoids.One hundred and seven consecutive patients were prospectively studied during a 2-year period in a general surgery ambulatory practice using a Redfield infrared coagulation system without anaesthesi...

To determine the management of perforated duodenal ulcer at the University Hospital of the West Indies (UHWI) in this era of Helicobacter pylori, the medical records of all patients seen at the UHWI during the period July 1997 to June 2002 with an intra-operative diagnosis of perforated peptic ulcer were reviewed The records were analyzed for the f...

Using the Department of Surgery, Radiology, Anaesthesia and Intensive Care's operative database and information from the Trauma Registry for patients presenting after 1998, a retrospective study of patients seen between the period 1992 and 2002 was done at the University Hospital of the West Indies with the objective of determining the treatment an...

All patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) at the University Hospital of the West Indies (UHWI) were entered into a prospective database. Parameters included demographics, indication for the procedure, success of the ERCP and any immediate complications noted. Retrospectively, the patients' case notes were analyze...

The aim of this study was to examine the clinical and pathological characteristics of colorectal cancer in Jamaica, to determine whether there was a change in the anatomic distribution and clinical presentation and to discuss the options for diagnosis and management. A comprehensive retrospective review of patients newly diagnosed with colorectal c...

This paper reports one case of pancreatitis and duodenal obstruction that occurred following repair of an abdominal aortic aneurysm. The patient had neither antecedent biliary or pancreatic disease nor alcohol abuse. The presentation was mild and the patient had an uneventful recovery without surgery. We present this uncommon entity and review the...

This paper reports two cases of benign hepatic cysts successfully treated by the instillation of tetracycline hydrochloride. The patients presented with solitary large symptomatic hepatic cysts and underwent ultrasound guided needle aspiration followed by the instillation of tetracycline hydrochloride. The cyst size diminished without complication...

The diagnosis and effective treatment of benign breast disease still remains a clinical challenge and the need for surgical intervention has not been clearly defined. To determine the patterns of benign breast disease in an Afro-Caribbean population in order to define the patterns of disease encountered and to review the approach to diagnosis and t...

Villous tumors of the duodenum are rare tumors which have been infrequently reported in the literature. Surgical treatment options include wide local excision and radical pancreaticoduodenectomy. A case of duodenal villous adenoma presenting with bilious vomiting is presented here.

The objective of this study was to determine whether analgesia-sedation improved patient acceptance of day-case herniorrhaphy and to evaluate the extent of patient morbidity. A total of 98 patients (mean age 34 years, range 17-75 years) were studied before and after herniorrhaphy to determine their response to the procedure. All patients were unpre...

Massive ascites is an unusual association with endometriosis. This case report is of such a condition in an Afro-Jamaican woman. The diagnosis was made at laparotomy and conservative treatment was adopted allowing for retention of reproductive function. Postoperative therapy was Goserelin, a Gonadotropin Releasing Hormone (GnRH) agonist, for six mo...

A consecutive series of 14 patients with anterior abdominal stab wounds and omental evisceration treated at the Kingston Public Hospital Jamaica over a 3-year period is presented. During this period 223 patients with abdominal stab wounds were seen of which 66 had omental evisceration. Conservative surgical management was the approach followed in 1...

One hundred and twelve patients with penetrating abdominal injuries seen at the Kingston Public Hospital, Jamaica, over a twelve month period from January 1 to December 31, 1992 were reviewed. Seventy-five (67%) patients had stab wounds and thirty-seven (33%) sustained gunshot wounds. There were 10 deaths (27%) from gunshot wounds, and seven deaths...

This study represents a review of 33 patients seen at the Kingston Public Hospital, Jamaica, with penetrating cardiac injuries over a 7-year period from 1982 to 1989. Male patients between the ages of 12 and 30 years accounted for more than 80 per cent of cases. A history of syncope associated with haemodynamic instability were the predominant clin...

A review of 60 patients with primary small bowel tumours seen at the University Hospital, Jamaica, during the 15 year period 1971-1985, revealed that adenocarcinoma was the commonest tumour (27%), followed by smooth muscle tumour (23%), and carcinoids (11%). There were 32 malignant and 28 benign tumours. The mean age at presentation was 56 years, w...